Provider Demographics
NPI:1316838105
Name:WESLEY, TRACY TRINESE
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:TRINESE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 SW EAST DANVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5942
Mailing Address - Country:US
Mailing Address - Phone:305-610-0941
Mailing Address - Fax:
Practice Address - Street 1:139 SW EAST DANVILLE CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5942
Practice Address - Country:US
Practice Address - Phone:305-610-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9547374163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management